The New Resistant Staph Epidemic

DAVID L. SMITH M.D.

Six things I want to tell you about this new epidemic:

1. This germ affects the healthy and the unhealthy—in or out of the hospital
2. If this germ gets onto your body you are 5-10 times more likely to develop disease i.e. boils or worse than the “old” Staph.
3. Many of the older and popular antibiotics are not effective against the “new” Staph.
4. To get “rid” of these bacteria requires not only proper antibiotic treatment perhaps with drainage but disinfection of our nose and skin where the bacteria may live and later cause disease with a break in our skin.
5. If one member of a household gets the bug—all the members need to be checked. Some may be carrying it—and it needs to be disinfected before it causes problems.
6. If you are going to have elective surgery or a possible C section—it is important to be sure you are not carrying this germ—as a surgical incision provides a way for the germ to enter our body and cause disease.

Staph, boils, risings, spider bites: All of these names refer to the most common serious contagious bacterial infection that humans encounter.

In the community, we are primarily exposed to the bacteria through contact with individuals who have been a patient work or reside in such facilities as hospitals, nursing homes, day care facilities or dialysis units. Schools and athletic teams have also experienced “Staph” outbreaks.

The common method of acquiring this organism is by direct physical contact with another person who is shedding the bacteria. The person who has the “staph” could have an obvious lesion such as a boil or impetigo. Many times the “staph” is not obvious but is being carried without signs or symptoms in the “staph carrier”. Such individuals can then transmit the “staph” to another person usually be direct physical contact. The second person now carries the “staph” and may then be a carrier or develop active disease soon after the staph has been transmitted. If the patient initially becomes a carrier—there is about a 30% chance he/she will develop active disease over a 6 month period. Commonly the bacteria initially set up “housekeeping” in the front part of the inside of our nose or under our fingernails.

In the community, the bacteria are patient and waits for some type of skin breakdown (as intact skin is a powerful protective shield) such as a cut, scrape or burn. This enables the “staph” to move from the surface and thus to get beneath our skin. Typically the disease produced is a boil.

In the hospital, Staph aureus is the number 1 organism. It is most commonly seen in surgical wound infections but may display a wide range of presentations. More patients die each year from staphylococcal infections than from AIDS.  Strong infection control programs with an emphasis towards hand washing before and after each patient contact –attempt to lower the burden of “staph” illness in the hospital.

Once “staph” infection affects one family/household member—all other individuals in close contact with that infected individual are at risk of acquiring the organism by close personal contact. The acquisition by other family members commonly may even precede the first or “index” case in a family. Infection control practices are not commonly practiced in the home—thus the spread of the germ is much easier than in the hospital.

New and more toxic strains of staphylococci began to circulate in our country around the 2000.They have rapidly taken over the universe of “staph”and pushed the older strains out of the community and hospital. Such strains now represent approximately 80% of all “staph” in the hospital and community. These new strains are uniformly resistant to many of the older anti-staphylococcal antibiotics. The boil lesions produced by them often have a black center and can be confused with a brown recluse spider bite.

In the community—individuals must suspect these new “staph”strains in all boils but particularly those with a dark center. Proper antibiotics with or without drainage must be given to treat the active disease. Individuals who have these boils/impetigo and their close personal/household./family contacts need to have hand and nose cultures. If either are positive—-specific disinfection-not oral antibiotics needs to be used and patients need to be re-cultured after treatment to make sure that the disinfection has worked. Special  ointment anti-infectives and soaps are used to accomplish this disinfection. All culture positive individuals need to be followed for at least 1 year to see that the “staph” does not relapse or return. Once “staph” gets into a family unit the members can “ping-pong” the disease back and forth for prolonged periods of time.

Certain medical conditions such as diabetes, obesity or tobacco addiction predispose to “staph” infections.

I strongly advise individuals in whom either elective surgery or possible C-section are contemplated—to make sure that they have nose cultures done before undergoing the procedure. It appears that patients are bringing these strains into the hospital and then they spread to the surgical wound. The above predisposing conditions greatly enhance your risk of such infections. If you have any of the following please notify your doctor so that additional measures may be taken:

1. Contact with hospital, nursing home or other medical facility or with individuals who have had contact with the above areas.
2. Recent history of boils in yourself or in family members.

Hopefully, I have convinced you of the 6 points I set out to make at the start of this article.

The MRSA Clinic of Mississippi is a Division of the Center of Infectious Disease Excellence at River Oaks Hospital. It is a resource for individuals and for organizations. It is specifically committed to the prevention, diagnosis d eradication of staphylococcal infections. The MRSA Clinic’s medical supervision is provided by David L. Smith M.D. Dr. Smith has guided and directed more than 300 clinical studies and is the senior practicing infectious disease individual in the state of Mississippi. Dr. Smith is a Clinical Professor of Medicine at the University of Mississippi School of Medicine. Connie Brinson is the Administrator and Nurse Clinician in the Clinic.

The clinic is located:

1040 River Oaks Drive (immediately to the South of Marty’s Pharmacy)
Suite 303
Flowood Ms. 39232
Telephone 601-936-0706
Fax-601-936-6150
e-mail: mrsaclinicofmississippi@comcast.net